Abstract

Background: In dengue virus infection, high levels of viremia is associated with involvement of multiple organs (liver, brain) in the severe form of the disease. The liver is the commonest organ to be involved in dengue.
Case report: We describe a case of severe dengue in 1 year old female child which was complicated by acute fulminant hepatitis (AFH), secondary hemophagocytic lymphohistiocytosis (HLH), encephalopathy and respiratory failure. Severe dengue was managed according to dengue protocol with ventilator support. N –
acetylcystine infusion was given for acute fulminant hepatitis. Liver functions and encephalopathy improved with N –acetylcystine infusion. HLH was diagnosed according to the diagnostic criteria of the histiocyte society and intravenous immunoglobulin (IV Ig) was given as treatment. Child improved with IV Ig and was discharged.

Key words: Severe dengue; Acute fulminant hepatitis; Hemophagocytic Lymphohistiocytosis